HSS Study: Delay in Rotator Cuff Repair Associated with “Significant” Increase Revision Surgery

Elizabeth Hofheinz, M.P.H., M.Ed.

Although the field is swimming in rotator cuff data, we did, apparently, need a bit more.

To that end, a new study, “Delay to Arthroscopic Rotator Cuff Repair Is Associated With Increased Risk of Revision Rotator Cuff Surgery,” appears in the October 1, 2020 edition of Orthopedics.

One of the authors was Michael Fu, M.D., a sports medicine surgeon at Hospital for Special Surgery (HSS). Asked what clinical issues he has seen with delays in the past, Dr. Fu told OSN, “Certainly not all rotator cuff tears require surgery, but those that fail to respond to non-surgical treatment can worsen over time. The rotator cuff muscles progressively atrophy and are replaced by fat through a process called fatty infiltration, which appears to be irreversible based on the available literature. The torn tendon also becomes retracted, scarred, and harder to repair. As this continues to be left untreated, a reparable rotator cuff tear can become irreparable over time. Eventually, the patient may develop cuff tear arthropathy, which is a specific pattern of shoulder arthritis caused by a chronic rotator cuff tear, for which the most consistent treatment is typically a reverse total shoulder replacement.”

For this study, the team analyzed data from 2,759 patients with minimum 5-year follow-up; 1510 (54.7%) had early repair within 6 weeks of diagnosis, 1,104 (40.0%) had routine repair between 6 weeks and 12 months after diagnosis, and 145 (5.3%) had a delayed repair (i.e, more than 12 months after initial diagnosis of rotator cuff tear).

“The overall revision surgery rate was 9.6% within 5 years,” wrote the authors. “Across the time to surgery cohorts, the revision rate was 9.9% in the early repair group, 8.3% in the routine repair group, and 15.2% in the delayed repair group. On bivariate analysis, the differences in re-vision rates between the delayed repair group and both the early and the routine repair groups were statistically significant. The difference in revision rates between the early and routine repair groups was not statistically significant. On multivariate logistic regression analysis, delayed repair was associated with significantly increased odds of sub-sequent revision surgery…”

Dr. Fu: “The most important result is that there appears to be an association between a delay from the time of initial rotator cuff tear diagnosis to the time of rotator cuff repair, and the need for subsequent revision rotator cuff surgery due to repair failure. We found that a delay of more than 12 months from rotator cuff tear diagnosis to rotator cuff repair was associated with a significant increase in the rate of undergoing revision surgery in the future.”

“A significant percentage of patients I see in the office with rotator cuff tears can still be successfully treated non-surgically, and there are factors that influence their prognosis such as age, tear size, activity level, muscle quality, etc. Based on the results of this study and our clinical experience, however, patients that have failed non-surgical treatment are advised that delaying rotator cuff repair may be associated with worse outcomes. Ideally, rotator cuff repair should be performed within 12 months of their rotator cuff tear diagnosis to optimize the chances of restoring shoulder function, relieving pain, and returning to the activities they love.”